Recommended Medications for Bacterial Vaginosis
For non-pregnant women with bacterial vaginosis, the recommended first-line treatment is metronidazole 500 mg orally twice daily for 7 days, clindamycin cream 2% one full applicator (5 g) intravaginally at bedtime for 7 days, or metronidazole gel 0.75% one full applicator (5 g) intravaginally twice daily for 5 days. 1
First-Line Treatment Options
For non-pregnant women, three equally effective first-line options are available:
- Oral metronidazole: 500 mg twice daily for 7 days
- Clindamycin cream: 2% one full applicator (5 g) intravaginally at bedtime for 7 days
- Metronidazole gel: 0.75% one full applicator (5 g) intravaginally twice daily for 5 days
Clinical trials have demonstrated that these regimens have similar cure rates of approximately 75-82% 1.
Alternative Treatment Options
If first-line treatments are not suitable, alternative regimens include:
- Single-dose metronidazole: 2 g orally in a single dose
- Oral clindamycin: 300 mg twice daily for 7 days
- Tinidazole: 2 g orally once daily for 2 days OR 1 g orally once daily for 5 days 2
Tinidazole has shown superior efficacy over placebo in clinical trials, with therapeutic cure rates of 36.8% for the 5-day regimen and 27.4% for the 2-day regimen 2.
Treatment in Pregnancy
For pregnant women, the recommended treatment is:
- Oral metronidazole: 250 mg three times daily for 7 days 1
This regimen balances efficacy with minimizing fetal exposure. High-risk pregnant women (those with previous preterm birth) should be screened and treated to reduce the risk of preterm delivery 1.
Important Precautions
- Alcohol restriction: Patients must avoid alcohol during metronidazole or tinidazole treatment and for 24 hours afterward (3 days for tinidazole) to prevent disulfiram-like reactions 1, 2
- Latex products: Clindamycin cream and ovules are oil-based and may weaken latex condoms and diaphragms 1
- Administration: Taking tinidazole with food minimizes gastrointestinal side effects without affecting bioavailability 2
Management of Recurrent BV
Recurrence is common, with 50-80% of women experiencing recurrence within a year of treatment 1. For recurrent BV:
- Use a different treatment regimen from the initial one
- Patients should return for additional therapy if symptoms recur
Partner Treatment
Routine treatment of sex partners is not recommended, as clinical trials indicate that partner treatment does not affect a woman's response to therapy or likelihood of recurrence 1.
Follow-Up
- Follow-up visits are unnecessary if symptoms resolve in non-pregnant women
- High-risk pregnant women should have follow-up evaluation 1 month after treatment completion 1
Pre-Procedure Considerations
Before surgical procedures, screening and treating women with bacterial vaginosis in addition to routine prophylaxis may reduce post-operative infectious complications 1.